Insurance Status a Factor in Trauma Care, Study Says

Insured patients who are admitted to non-trauma hospitals may be getting "suboptimal" care in comparison to uninsured trauma patients who are "dumped" or transferred to trauma centers, a counterintuitive study finding suggests.

Emergency doctors at non-trauma hospitals are less likely to transfer severely injured patients to a designated trauma center if the patients are insured than if they are not insured, according to a study published in JAMA Surgery.

The implication is that insured patients admitted to non-trauma hospitals may be getting "suboptimal" care simply because hospitals want to keep patients whose care would be well reimbursed compared with patients without health insurance coverage.

Researchers from the University of Pennsylvania Department of Emergency Medicine say the problem is well documented and serious enough that a law should be passed to prohibit the practice, much like the anti-dumping law, which requires hospitals to give stabilizing care to any patient, regardless of ability to pay, before transferring them.

"I don't think these decisions are being made maliciously," says M. Kit Delgado, MD, principal author of the report. "I think it's that these might be (ED doctors) who work in pretty big hospitals that have some resources, like neurosurgeons and orthopedic surgeons, and (they) honestly feel (they) can take care of those patients."

But the evidence shows that with severely injured patients, clinicians can't always provide the best care quickly enough.